The CT Title V Program and our partners recognize the importance of access to a comprehensive health and mental health care system for all children, with a focus on underserved children and health equity. CT Title V works to advance improvements in collaboration with providers, policymakers, consumers, and state agencies with an emphasis placed on developmental promotion, developmental monitoring, early screening, evaluation, and intervention.

CT continues to support activities identified in the completed HRSA State Implementation Grant for Improving Services for Children and Youth with Autism Spectrum Disorders and other Developmental Disabilities to improve access to comprehensive, coordinated health and related services. The grant was a collaborative project between DPH, and A.J. Pappanikou Center Connecticut’s University Center for Excellence on Developmental Disabilities (UCEDD). Proposed outcomes of the project included: (1) implementation of the CT State Autism Plan, with activities that strengthen stakeholders’ awareness of early signs of ASD; knowledge about and access to evidenced-based, individualized and timely screening; diagnostic assessment and interventions implemented by a competent workforce; (2) engage ASD specific family support and training organizations to provide information and education on ASD; (3) work with the AAP, pediatric primary and family care providers, and the CT Medical Home Initiative for CYSHCN (CMHI) staff to expand the number of practices providing family- centered, comprehensive, coordinated health care and related services including screening, linkage to diagnosis, and transition to evidence-based interventions.

Report numbers include the following: training on the importance of developmental screening and supporting materials were provided once again to 2,000 families and 3,500 professionals for a total of 138 trainings; Community outreach activities and distribution of developmental screening materials totaled 25,269 and “Learn the Signs. Act Early.” products were distributed 6,213 times during the project period.

CT DPH and the UCEDD continued our shared partnership of the Center for Disease Control and Prevention (CDC’s) “Learn the Signs. Act Early.” Ambassador position as Bethanne Vergean, Early Childhood Technical Assistant from the UCEDD, is Connecticut’s Ambassador. The program aims to improve early identification of children with developmental disabilities including autism to raise awareness of the importance of screening and early identification through the distribution of materials for parents and professionals working with young children. “Learn the Signs. Act Early.” trainings were provided statewide to 30 Early Childhood programs; 72 pediatricians; and 32 Community Providers. The “Learn the Signs. Act Early.” Connecticut Facebook Page has 602 followers and 558 likes. They also partnered with Reach out and Read at CT community health centers to provide 3,200 Baby Busy Day, CDC Books. CT Learn the Signs Milestones are also now located in the Sparkler App at https://www.playsparkler.org/.

Developmental screening is a priority area and contains three Action Agenda strategies.

Data Source: National Survey of Children’s Health, Health Resources and Services Administration, Maternal and Child Health Bureau. https://mchb.hrsa.gov/data/national-surveys

According to the National Survey of Children’s Health, Health Resources and Services Administration, Maternal and Child Health Bureau, the percent of children, ages 9 through 35 months, who received a developmental screening using a parent-completed screening tool in 2020-2021 was 34.80% Nationwide and 36.80% in Connecticut. In contrast to 65.20% for parents who did not complete a developmental screening tool and 63.20% in Connecticut. Connecticut’s percentage is much higher than the national average.

The first strategy is to conduct an education and awareness campaign that targets families and communities on the importance of developmental screening. The media campaign message includes information on and the promotion of developmental screening, a focus on families & relationships, and the Strengthening Families’ Protective Factors. The success of the campaign is monitored through the counting of several screening and referrals items available through Child Development Infoline and are tracked overtime. Ages and Stages Questionnaires (ASQ) new enrollments 7,649; ASQ Screenings Completed 9,537; Birth to Three referrals 11,386; ASQ web hits 3,247; ASQ enrollment from web hits 411; total ASQ enrollments13,187, Promote awareness and use of Child Development Infoline, Total number of Child Development Infoline and Help Me Grow (CDI/HMG) calls is 3,813; CDI/HMG cases related to monitoring a child’s development 375; Help Me Grow Referrals 3,508. Expand the number of “Learn the Signs. Act Early.” materials distributed statewide to families and community providers 1,029; “Learn The Signs. Act Early.” web hits at Child Development Infoline 171.

Data Source: CDI/HMG Data 2016-2022

According to Child Development Infoline/Help Me Grow (CDI/HMG) Data, the total number of CDI/HMG calls from 2016-2021 was 2,841; 3,285; 2,850, 3,002; 2,927; and 3,813 respectively. The number of cases from 2016-2021 was 749; 714; 420; 571; 428; and 375.

The second strategy is to train community and healthcare providers to improve screening rates and coordination of referrals and linkages to services within the state. Success is tracked through a variety of Educating Practices trainings. The Educating Practices program offers 20 training topics to help pediatric practices across Connecticut improve delivery of child health services.

From July 1, 2021, to June 30, 2022, the Educating Practices program offered 20 training topics to help pediatric practices across Connecticut improve delivery of child health services. From July 1, 2021, to June 30, 2022, seven (7) trainings were completed at five pediatric and ob/gyn practices and included 71 participants. During this period, the program transitioned from CHDI (Child Health and Development Institute) to Connecticut Children’s and the contract did not start until March 2022. As a result, the program did not function fully during the transition.

Due to the ongoing COVID-19 Pandemic, the CT Association for Infant Mental Health (CT-AIMH) was still offering all trainings and conferences virtually. In 2022 they offered one (1) virtual spring statewide conference for 140 people and one (1) virtual fall conference for 200 people. In addition, they offered four (4) different virtual CT-AIMH infant and toddler audience-specific training series that included 170 people, for a total of 510 trained. They now have over 100 Infant and Early Childhood Mental Health Endorsed professionals.

The third strategy is to engage in cross system planning and coordination of activities around developmental screening. Members of the Developmental Screening Workgroup joined state level groups to support communication among and coordination of statewide efforts around developmental screening and the promotion of healthy development through the Help Me Grow Advisory Council. The Help Me Grow Advisory Council has come together to address many issues that are facing the community in CT. One meeting featured a presentation on the SEI-FASD (Substance Exposed Infant-Fetal Alcohol Spectrum Disorders) statewide initiative’s work. This initiative aims to strengthen capacity at the community, provider, and systems levels to improve the safety, health, and well-being of substance exposed infants and support the recovery of pregnant and parenting birthing people and their families. It is funded by the Department of Mental Health and Addiction Services (DMHAS) and the Department of Children and Families (DCF).

In addition, resources at 2-1-1 Infoline allows for phone and digital access to educational information, screening resources and connectivity to support services; expansion of parent participation at the state level young child wellness council and linkage to national parenting activities; and partnering with local schools around initiatives that support family strengthening. Information is available on a variety of resources including: Text4baby, a free service for pregnant and new moms that offers tips on baby development, pregnancy, and childcare; Milestone Tracker Mobile app to track your child’s development from age 2 months to 5 years which includes tips on development and what to do if you are ever concerned; support from the Early Childhood Consultation Partnership that provides early childhood mental health promotion, prevention and intervention services to children who are at risk of suspension or expulsion from early care and education settings due to behavioral and mental  health concerns; and Vroom, an app that provides parents with science-based tips and tools to give a child a great start in life.

DPH staff continued to distribute the “Learn the Signs.Act Early” Milestones Moments Booklets in both English and Spanish which include Connecticut specific information for referral to 2-1-1 Child Development Infoline. The logos of “Learn the Signs.Act Early”, 2-1-1 Child Development Infoline, CT Department of Public Health, UCONN Center for Excellence in Developmental Disabilities, and the Office of Early Childhood were added previously to reflect the collaborative efforts to support developmental monitoring, screening and referral in CT. Combined funding allowed the printing of 7,500 of English and 7,500 Spanish “Learn the Signs.Act Early” Milestone Moments Booklet and Track Your Child’s Developmental Milestones Brochures.  Printed materials were shared with all partners for distribution through their community networks and materials are available from 2-1-1 Child Development Infoline for statewide distribution.

Each regional Screening to Succeed Community Education Session identified developmental awareness and screening activities to focus on in the coming year some examples include the following; improve outreach to families with an emphasis on fathers, ensure cultural competence, enhance support for screening in Primary Care settings, provide screenings at Family Resource Centers, and complete Ages and Stages Questionnaires (ASQ) at enrollment.

The Help Me Grow Advisory Council continued its mission to ensure screening and follow-up services are accessible and fully integrated and to build capacity of the system to respond to increased need for referrals and services. The Help Me Grow Advisory Council developed out of the Early Childhood Comprehensive Systems grant that had an Action Plan that utilized national materials shared at the CT Act Early meeting including the adoption of objectives such as establishing a statewide learning collaborative and creating a marketing message to emphases the promotion of good health/development.

Children’s brains grow rapidly in their earliest years, laying the foundation for the rest of their lives with learning fueled by play and interactions between children and their parents and caregivers. Sparkler was piloted in five communities in the State of Connecticut, and it has been introduced in more than 70 communities to help all children in the state get off to a strong start through regular developmental screening, ongoing play-based learning, and connection to local resources. Sparkler allows families to: Know: Understand their child’s development with the mobile Ages & Stages Questionnaires® (ASQ); Play: Spark learning with fun, off-screen activities to play together and tips for parents; Grow: Follow their child’s progress in their Sparkler scrapbook; and Connect: Get tips and answers from experts at 211 Child Development or their school/provider. Providers in Connecticut have the option of using Sparkler’s web-based dashboard for free to engage the families they serve with messaging, screening, co-play activities, and more.

The MAVEN online reporting system is available to care coordinators within the CT Medical Home Initiative for Children and Youth with Special Health Care Needs (CMHI) with enhanced fields specifically related to developmental screening. Fields include whether the child received a developmental screening, screening results, confirmation of screening results and referrals made. This mandatory data entry gathered information from parents on developmental screening of CYSHCN under the age of four who are currently served by CMHI contractors.

The Autism Services & Resources Connecticut houses the user-friendly clearing house on their website at https://ct-asrc.org/professional-resource-guide/. The guide is a user-friendly clearinghouse to facilitate access to services, catalog resources currently available (federal, state, private), catalog qualified professionals/facilities based on Qualified Credentialing Application; and catalog existing training opportunities for parents and professionals. DPH staff serve as the liaison for the comprehensive resource guide initiative and the training initiative.

The Medical Home Advisory Council (MHAC) was established to provide guidance and advice to the CT Department of Public Health in its efforts to improve the community-based system of care for children and youth with special health care needs (CYSHCN) by ensuring their connection to a medical home that is accessible, compassionate, comprehensive, coordinated, continuous, culturally effective, and family-centered. Parents representing different organizations are at the table including staff from the CT Family Support Network (CTSFN). CTFSN provides direct support to individuals and families in their homes and communities by sharing information and resources that empower people to make their voices heard and to become their own best advocate.

The DPH MHAC has a Family Experience Workgroup who provides consistent support for quarterly meetings and offers a gateway to additional family voices through the facilitation of focus groups on behalf of the consumer input section of the MCHBG. The Family Experience Workgroup serves as a conduit to ensure a broad representation of family experiences are shared with Council members and to distribute materials and information gathered at MHAC and Family Experience meetings to families statewide. One presentation entitled “COVID-19: Where do we go from here?” by John Schreiber, MD, MPH from Connecticut Children’s discussed misinformation surrounding COVID and how we have moved to an endemic. He also said that there is some misinformation about the Bivalent Omicron Booster and that 85% of Children have had COVID initial vaccination.

Immunizations

The Connecticut Department of Public Health Immunization Program provides all recommended childhood vaccines to approximately 663 providers statewide including private physician offices, community health centers, School Based Health Centers, urgent care centers and local health departments. In 2022, approximately 1,100,000 doses of vaccine were distributed by the Immunization Program and the program continues to universally offer all Advisory Committee on Immunization Practices (ACIP) vaccines for all children up through 18 years of age in Connecticut regardless of insurance status. Adult vaccines including HPV for uninsured patients 19-45 years of age are provided free of charge to local health departments, community health centers, STD clinics, and drug treatment facilities. Uninsured and Medicaid patients 9-18 years of age as well as privately insured 11- and 12-year-olds are also provided HPV vaccine. In Fiscal Year 2023, HPV vaccine will be expanded to include 13- and 18-year-old private insured patients. By July 1, 2024, all 11–18-year-old privately insured patients will be eligible to receive state supplied HPV vaccine.

The Connecticut Vaccine Program (CVP) is funded through a combination of state and federal monies. The state monies are from an assessment tax on all health insurers doing business in the state of Connecticut. This assessment allows us to provide most of all nationally recommended vaccines for privately insured children up through 18 years of age free of charge.

All nationally recommended childhood vaccines are provided to School Based Health Centers (SBHCs) for children up through 18 years of age free of charge. The Immunization Program also partners with the WIC program to promote timely immunizations and well-child exams at WIC locations statewide.

The Connecticut Immunization Information System (IIS) operated by the CT DPH generates immunization coverage rates on a statewide level, by practice and by Immunization Action Plan (IAP) areas. IAP areas are target areas of need and include IAP Coordinators, under the state immunization program’s contracts, who conduct outreach and tracking to raise immunization rates on preschool age children. In Fiscal Years 2021-2022, nine local Immunization Action Plan (IAP) Contracts (Hispanic Health Council, Ledge Light Health District, Naugatuck Valley Health District, New Britain Heath Department, New Haven Health Department, Norwalk Health Department, Southwestern AHEC, Torrington Area Health District, Waterbury Health Department) worked with providers, maternal and child health partners, and local WIC agencies to ensure that all children have a medical home to have access to age appropriate vaccinations.

IAP Coordinators and state immunization program Epidemiologists also conduct site visits called IQIP (Immunization Quality Improvement for Providers) with providers as a continuous quality improvement process developed by the CDC to raise immunization coverage rates, reduce missed opportunities to vaccinate, and improve standards of practice at the local level.

As of July 2022, the state law was updated requiring providers to electronically all vaccines for all ages to the Connecticut IIS. All children born in Connecticut are automatically enrolled through State Vital Records and from their provider offices, unless the parent or the adult patient opts out by sending a signed written permission to the CT DPH. Less than 1% of patients opt out of the IIS. CT IIS enables providers to report in real-time electronically from their electronic health records, query forecasts of which vaccines are due or overdue, and run reminder/recall and coverage reports.

Office of Oral Health

The Office of Oral Health’s (OOH) CT Oral Health Surveillance System (COHSS) tracks and monitors over twenty oral health indicators for children. Of note, in 2021 per the CT Behavioral Risk Factor Surveillance Survey, 82.1% of CT children between the ages of 1 and 17 received an annual dental visit. Additionally, in 2020-2021, per the National Survey of Children’s Health, CT’s percentage of “dental visit among children aged 1-17 years with special health care needs” was 89.5%, which is above the national percentage at 83.1%. Lastly, in 2020, per CMS-416, for “preventive dental visit among children aged 1-20 years enrolled in Medicaid/SCHIP” CT’s percentage was 49.8%.

The OOH continues to implement the SEAL CT! program, a school-based sealant program, which aims to support the placement of dental sealants and the expansion of programs in schools where 50% or more students are eligible for the Free and Reduced Meal Program. In the last year, the OOH has implemented a Communications Plan for school-based dental sealant programs, which includes strategies to foster community and parent awareness, develop bilingual resources, and promote resources through the DPH website and social media. The OOH also developed a Sustainability Plan, which outlines strategies for continued implementation once federal funding is no longer available. Lastly, the OOH continues to convene the CT Dental Sealant Advisory comprised of staff representing school-based sealant programs, federally qualified health centers, and other state and local agencies to promote the use of sealants, share resources, and provide technical assistance to the SEAL CT! programs.

Nutrition, Physical Activity, and Obesity (NPAO) Program

The DPH Nutrition, Physical Activity, and Obesity (NPAO) Program has been working with early care and education (ECEs) sites to provide nutrition and physical activity education and support the creation of healthier environments for the children and families they serve for over 10 years. Over the years, these efforts have expanded with the receipt of new funding and development of new partnerships, including other DPH programs addressing children’s health and wellness.

In 2017, the NPAO Program partnered with the DPH Office of Oral Health to create Water First for Your Thirst! (WFFYT) initiative for ECE sites to increase the availability of fluoridated drinking water in ECE sites and promote fluoridated drinking water as the primary beverage for young children (birth to 5 years old). The WFFYT initiative was developed as a result of a group of partner organizations that wanted to improve sugary drink intake in young children and as an extension of an existing marketing and communications campaign developed by UConn Health.  The WFFYT initiative focused on providing training and support to ECE providers, including a self-directed toolkit, a training on implementation, and resources to use in classroom and on-site.  The WFFYT website provides consumer information and resources on the value of drinking and cooking with fluoridated water and healthy food choices. From 2017-2019, the WFFYT initiative was successfully implemented in 11 center-based and 66 home-based ECEs serving 1,014 children. Starting in 2019, the NPAO Program shifted to include the WFFYT initiative tools and resources as part of the Go Nutrition and Physical Activity Self-Assessment for Child Care (Go NAPSACC) initiative.

Go NAPSACC implementation began in 2019 with center and home-based ECEs to address childhood obesity with funding from the Centers for Disease Control and Prevention (CDC) State Physical Activity and Nutrition Program (SPAN) and U.S. Department of Agriculture (USDA) Supplemental Nutrition Assistance Program-Education (SNAP-Ed) funding.  Go NAPSACC is an evidence-based online platform that helps ECEs create a healthier environment for the children they serve through a five-step improvement process: best practice assessment, action planning, implementation, training and technical assistance support, and re-assessment to evaluate progress. Best practices include policy, systems, and environmental changes to support healthy behaviors and are grouped into seven modules: Breastfeeding & Infant Feeding, Child Nutrition, Farm to ECE, Oral Health, Infant & Child Physical Activity, Outdoor Play & Learning, and Screen Time.  ECEs that opt to work on the Oral Health module will also receive the WFFYT toolkit and resources described earlier.

Participating ECEs receive the following supports as part of the Go NAPSACC initiative: 

• Unlimited access to the online Go NAPSACC platform, which includes self-assessments, action planning tools, materials and resources, and online training for each module.
• A dedicated technical assistance consultant (TA) to help them through the process, address barriers, and monitor progress.
• Implementation resources including toolkits, classroom materials and supplies, and educational handouts for families.

Recruitment occurs on a rolling basis throughout the year, and participating ECEs complete the selected module(s) at their own pace. Implementation of one or more modules typically occurs over a six to nine-month period, depending on the number of action items identified, the ECE site’s time, and any barriers faced during implementation.  From October 1, 2021 - September 30, 2022, 65 sites were actively working through Go NAPSACC, reaching 2,295 children. The Oral Health module specifically addresses reducing sugary beverages and increasing plain fluoridated drinking water access in ECE sites. Of these 65 sites, a total of 53 sites completed at least one nutrition or physical activity module. Forty-eight completed the nutrition-focused modules (Breastfeeding & Infant Feeding, Child Nutrition, Farm to ECE, or Oral Health), 5 completed the physical activity-focused modules (Outdoor Play and Physical Activity), and no programs completed the Screen Time module. The remaining 12 programs continue to work through the intervention into the next fiscal year.    The NPAO Program continues to work with TAs to ensure sites that start the process complete the full Go NAPSACC implementation process, including a second self-assessment to measure changes in best practice attainment. The below chart includes a summary of mean scores for those providers that completed one or more of the 7 available modules. The most significant improvements occurred t in sites working in the Breastfeeding and Infant Feeding, Outdoor Learning and Play, and Physical Activity modules.

The NPAO Program, in partnership with the University of St. Joseph (USJ) is also implementing Coordinated Approach to Child Health (CATCH) Early Childhood (CEC) in ECE sites with SNAP-Ed funding.  Modeled after the nationally recognized CATCH Program for grades K-12, CEC is an obesity prevention intervention designed to increase physical activity and promote healthy eating in children ages 3-5. ECE staff are trained to deliver CEC curriculum in their classrooms, which includes nutrition and gardening lessons and 30 minutes of daily physical activity in the classroom. Limitations related to the continued COVID-19 pandemic limited the NPAO Program’s ability to provide in-person services as broadly as intended. However, the NPAO Program partnered with CATCH Global to provide one in-person CEC Training Academy during the reporting period. The CEC Training Academy included in-person CEC training for 18 ECE classroom teachers for implementation, but also provided 6 SNAP-Ed staff and contractors the opportunity to recertify as CEC trainers so that DPH staff and contractors can independently resume in-person training during the next federal fiscal year. Technical assistance was offered remotely to support implementation following the virtual training. Year-end reporting indicated a total of 21 ECE programs actively implemented CEC during the reporting period. Of these 21 programs, 10 were trained during this period, and 11 were trained previously. A combined average of 52% of classrooms are implementing CEC out of a possible 122 reported classrooms. Of these 21 programs, 10 implementing programs reported teaching the CEC curriculum and implementing the CEC Coordination Toolkit, and 14 implementing programs reported distribution of parent handouts. Roughly 50% of sites that completed the year-end report noted significant challenges with implementation due to continued barriers associated with the pandemic. This is a major improvement compared to last year, where 100% of respondents indicated COVID-19 related challenges.

ECE programs reported through Survey Monkey on the number of children and staff at their locations. Data for this reporting period showed a total of 13 ECE programs reported 1,405 children and 18 staff were reached. In addition, as part of the CATCH Early Childhood curriculum, nutrition education materials with activities were given to the children to share and interact with their parents. According to the US Census Bureau American Community Survey, 34% of Connecticut kids live with a single parent (478 parents) and 66% live with both parents (1,855 parents); or 2,333 parents reached. Thus, the total reached was estimated to be 3,756 (1,405+18+2,333).

Funded by SNAP-Ed, the NPAO Program in collaboration with USJ delivers evidence-based nutrition and physical activity education sessions and workshops for the parents/caregivers of young children with the goal of improving overall nutrition and increasing physical activity of families.  Parents/caregivers are targeted as they have the most influence on food choices and are able to enforce healthy messages within their families. The educational content is based on Eating Smart • Being Active, a curriculum developed at Colorado State University and University of California at Davis for low-income adults with young children. The program curriculum has eight different topics: Get Moving, Plan Shop Save, Fruits and Veggies Half Your Plate, Make Half Your Grains Whole, Build Strong Bones, Go Lean with Protein, Make a Change, and Celebrate! Eat Smart and Be Active.  ECE sites participating in Go NAPSACC and CEC are targeted for these sessions and workshops to employ a layered approach to obesity prevention.  From October 1, 2021 - September 30, 2022, 222 sessions and workshops were delivered to 2,238 unduplicated participants.

The NPAO Program worked with MCH Block Grant staff to develop a one-page handout for School Based Health Center staff outlining existing nutrition education materials for distribution to students and their families on reducing sugary drinks, provided in English and Spanish.  The handout was completed during this reporting period and received internal approval for distribution to SBHC’s partners.